The pharmacotherapy of cirrhosis: concerns and proposed investigations and solutions

• Published in: Journal of clinical pharmacy and therapeutics Vol. 41; no. 6; pp. 587 - 591
• Main Authors: Hilscher, M. B., Odell, L. J., Myhre, L. J., Prokop, L., Talwalkar, J.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.12.2016; Hindawi Limited
• Subjects: Angiotensin Receptor Antagonists - adverse effects; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - adverse effects; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; drug interaction; Drug-Related Side Effects and Adverse Reactions - etiology; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; liver; Liver - drug effects; Liver Cirrhosis - drug therapy; pharmacists; Retrospective Studies; liver; pharmacists; drug interaction
• ISSN: 0269-4727; 1365-2710
• DOI: 10.1111/jcpt.12443

Summary What is known and objective The presence of cirrhosis has a multifaceted impact on hepatic drug metabolism. An area of concern and uncertainty in the care of patients with cirrhosis is the safe use of both prescription and over‐the‐counter medications. Comment Retrospective studies indicate a high incidence of adverse drug reactions (ADRs) among patients with cirrhosis related to use of certain medication classes including angiotensin‐converting enzyme inhibitors, angiotensin receptor blockers and non‐steroidal anti‐inflammatory drugs. Conversely, use of appropriate medications, such as statins, may be decreased in this population due to fear of precipitating hepatotoxicity. What is new and conclusion Pharmacotherapy in cirrhosis is an area of uncertainty and heterogeneity in clinical practice. Prescribing and dosing guidelines are needed to decrease the risk of serious ADRs in this high‐risk patient population. Pharmacotherapy in cirrhosis is an area of uncertainty and heterogeneity in clinical practice. Retrospective studies demonstrate a high incidence of ADRs related to unsafe medication prescribing habits or incorrect dosing. Safe prescribing in cirrhosis could be augmented through the creation of specific dosing guidelines and perhaps increased involvement of pharmacists.